Nihon Kohden ZM-940PA Telemetry Medical Transmitter User Manual Cover 2 ZM940PA OM pmd
Nihon Kohden Corporation Telemetry Medical Transmitter Cover 2 ZM940PA OM pmd
User Manual
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| Document Description | User Manual |
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| Date Submitted | 2005-05-16 00:00:00 |
| Date Available | 2005-06-30 00:00:00 |
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TRANSMITTER ZM-940PA 0614-009881 Model: ZM-940PA Manual code no.: 0614-009881 Reader Comment Card We welcome your comments about this manual. Your comments and suggestions help us improve our manuals. Please circle the number for each of the following statements corresponding to your evaluation and add comments in the space provided. Fax or send your completed comment card to: Fax: +81 (3) 5996-8100 International Div., Sales Promotion Section, Nihon Kohden Corp., 1-31-4, Nishiochiai Shinjuku-ku, Tokyo 161-8560, Japan Strongly Agree Agree Neutral Disagree Strongly Disagree 5 cutting line This manual is organized. I can find the information I want. The information is accurate. I can understand the instructions. The illustrations are appropriate and helpful. The manual length is appropriate. Comments: Thank you for your cooperation. We appreciate it very much. Name: Occupation/Position: Hospital/Company: Address: Phone: Contents GENERAL HANDLING PRECAUTIONS .................................................................... i WARRANTY POLICY ............................................................................................... iii Equipment Authorization Requirement ................................................................... iii EMC RELATED CAUTION ....................................................................................... iv Conventions Used in this Manual and Instrument ................................................. vii Warnings, Cautions and Notes ......................................................................... vii Explanations of the Symbols in this Manual and Instrument ........................... viii Introduction .................................................................................................................... 1 Panel Description .......................................................................................................... 2 Front Panel ............................................................................................................... 2 Rear Panel ............................................................................................................... 3 Top Panel ................................................................................................................. 4 Bottom Panel ............................................................................................................ 4 LCD .......................................................................................................................... 6 Note on Parameter Settings .......................................................................................... 8 Important Safety Information ......................................................................................... 9 General .................................................................................................................... 9 Output Signal ........................................................................................................... 9 Preparation .................................................................................................................. 10 Installing (Replacing) Batteries ............................................................................. 10 WARNING and CAUTION for Battery Handling ............................................... 10 Battery Lifetime ................................................................................................. 10 Installing (Replacing) Batteries ........................................................................ 11 Situations Requiring Battery Replacement ..................................................... 12 Battery Condition Indication ............................................................................. 12 Turning the Transmitter On/Off ............................................................................... 13 Turning On the Power ....................................................................................... 13 Turning Off the Power ....................................................................................... 13 Check Items Before Use .................................................................................. 13 Check Items After Power On ............................................................................ 14 Check Items After Use ...................................................................................... 14 Changing the Transmitter Channel ............................................................................. 15 Changing Parameter Setup Settings .......................................................................... 16 Parameter Setup Setting List ................................................................................. 16 Displaying the PARAMETER SETUP Screen ....................................................... 17 Changing Settings ................................................................................................. 18 Operator's Manual ZM-940PA SELECTABLE INTERVALS .............................................................................. INITIAL INTERVAL ............................................................................................ INITIAL CUFF PRESS ...................................................................................... NIBP MODE AFTER STAT ................................................................................ START/FINISH SOUND .................................................................................... OLD NIBP DATA/AFTER .................................................................................. INHIBIT SpO2 DURING NIBP ........................................................................... 2ND PARAMETER ........................................................................................... LEADS OFF DISPLAY ...................................................................................... ECG ELECTRODE ........................................................................................... Changing System Setup Settings ............................................................................... System Setup Setting List ...................................................................................... Displaying the SYSTEM SETUP Screen ............................................................... Changing Settings ................................................................................................. CHANNEL/TYPE .............................................................................................. PRESSURE UNIT ............................................................................................ LANGUAGE ...................................................................................................... BRIGHTNESS .................................................................................................. SYSTEM INITIALIZE ......................................................................................... Attaching NIBP Cuff, Electrodes and SpO2 Probe to the Patient ................................ Attachment Examples ............................................................................................ Attaching the NIBP Cuff ......................................................................................... Selecting the NIBP Cuff .................................................................................... Connecting the NIBP Cuff to the Transmitter .................................................... Attaching the NIBP Cuff to the Patient ............................................................. Attaching Electrodes .............................................................................................. Selecting Electrode Lead ................................................................................. Connecting the Electrode Lead to the Transmitter ........................................... Selecting the Electrode Position ...................................................................... Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes ..................................................................................... Electrode Position for Respiration Monitoring ................................................. Attaching the SpO2 Probe ...................................................................................... Selecting the SpO2 Probe ................................................................................ Connecting the SpO2 Probe to the Transmitter ................................................ Attaching the Probe to the Patient ................................................................... Locking the Keys on the Transmitter ........................................................................... Monitoring .................................................................................................................... NIBP Monitoring ..................................................................................................... Selecting the Initial Cuff Inflation Pressure ...................................................... Selecting the Measurement Mode and Interval ............................................... Measuring NIBP ............................................................................................... ii 18 18 18 19 19 19 20 20 21 21 22 22 22 23 23 23 24 24 24 25 25 26 26 29 31 35 35 36 36 40 41 43 43 46 46 48 49 49 49 49 50 Operator's Manual ZM-940PA Monitoring SpO2 during NIBP Measurement ................................................... ECG and Respiration Monitoring .......................................................................... Electrode Detachment ..................................................................................... SpO2 Monitoring ..................................................................................................... SpO2 and PR Display Order ............................................................................. Monitoring SpO2 during NIBP Measurement ................................................... Display and Message List ........................................................................................... Battery Indication ................................................................................................... ECG/Respiration .................................................................................................... SpO2 ....................................................................................................................... NIBP ....................................................................................................................... Troubleshooting ........................................................................................................... Transmitter ............................................................................................................. ECG/Respiration .................................................................................................... SpO2 ....................................................................................................................... NIBP ....................................................................................................................... Maintenance ................................................................................................................ 1. External Check ............................................................................................ 2. Transmitter Channel ..................................................................................... 3. LCD Display ................................................................................................. 4. Key Operation .............................................................................................. 5. NIBP Cuff for Attaching Transmitter to Patient Arm ...................................... Maintenance Check Sheet .................................................................................... Repair Parts Availability Policy .................................................................................... Lifetime and Disposal .................................................................................................. Disposing of Used Batteries .................................................................................. Battery Lifetime ................................................................................................. Disposal ........................................................................................................... Disposing of Electrodes, SpO2 Probes and NIBP Cuffs ........................................ Cleaning, Disinfection and Sterilization ...................................................................... Transmitter and Electrode Leads ........................................................................... Cleaning ........................................................................................................... Disinfection ....................................................................................................... SpO2 Probe ............................................................................................................ YP-943P/944P NIBP Cuffs ..................................................................................... Cleaning ........................................................................................................... Disinfection ....................................................................................................... Specifications .............................................................................................................. Measuring Parameters ..................................................................................... Transmitting Data ............................................................................................. Displayed Data ................................................................................................. ECG Measurement ........................................................................................... Operator's Manual ZM-940PA 53 53 55 56 57 57 59 59 59 60 61 62 62 63 63 64 66 66 66 68 69 70 71 72 73 73 73 73 73 74 74 74 74 75 75 75 75 76 76 76 76 76 iii Respiration Measurement ............................................................................... SpO2 Measurement .......................................................................................... NIBP Measurement .......................................................................................... Pulse Rate ........................................................................................................ Transmitter ........................................................................................................ Power Requirements ........................................................................................ Dimension and Weight ..................................................................................... Environment ..................................................................................................... Safety Standards .............................................................................................. Electromagnetic Compatibility ......................................................................... Electromagnetic Emissions .............................................................................. Electromagnetic Immunity ................................................................................ Recommended Separation Distance between Portable and Mobile RF Communications Equipment ............................................................................ System Composition for EMC Test ................................................................... Standard Accessories ................................................................................................. Options ........................................................................................................................ Transmitter ........................................................................................................ ECG/RESP ....................................................................................................... NIBP ................................................................................................................. SpO2 ................................................................................................................. Transmission Frequencies .......................................................................................... iv 76 76 77 77 77 77 77 78 78 79 79 80 82 82 83 84 84 84 84 85 86 Operator's Manual ZM-940PA GENERAL HANDLING PRECAUTIONS This device is intended for use only by qualified medical personnel. Use only Nihon Kohden approved products with this device. Use of non-approved products or in a non-approved manner may affect the performance specifications of the device. This includes, but is not limited to, batteries, recording paper, pens, extension cables, electrode leads, input boxes and AC power. Please read these precautions thoroughly before attempting to operate the instrument. 1. To safely and effectively use the instrument, its operation must be fully understood. 2. When installing or storing the instrument, take the following precautions: (1) Avoid moisture or contact with water, extreme atmospheric pressure, excessive humidity and temperatures, poorly ventilated areas, and dust, saline or sulphuric air. (2) Place the instrument on an even, level floor. Avoid vibration and mechanical shock, even during transport. (3) Avoid placing in an area where chemicals are stored or where there is danger of gas leakage. (4) The power line source to be applied to the instrument must correspond in frequency and voltage to product specifications, and have sufficient current capacity. (5) Choose a room where a proper grounding facility is available. 3. Before Operation (1) Check that the instrument is in perfect operating order. (2) Check that the instrument is grounded properly. (3) Check that all cords are connected properly. (4) Pay extra attention when the instrument is in combination with other instruments to avoid misdiagnosis or other problems. (5) All circuitry used for direct patient connection must be doubly checked. (6) Check that battery level is acceptable and battery condition is good when using batteryoperated models. 4. During Operation (1) Both the instrument and the patient must receive continual, careful attention. (2) Turn power off or remove electrodes and/or transducers when necessary to assure the patient’s safety. (3) Avoid direct contact between the instrument housing and the patient. 5. To Shutdown After Use (1) Turn power off with all controls returned to their original positions. (2) Remove the cords gently; do not use force to remove them. Operator's Manual ZM-940PA (3) Clean the instrument together with all accessories for their next use. 6. The instrument must receive expert, professional attention for maintenance and repairs. When the instrument is not functioning properly, it should be clearly marked to avoid operation while it is out of order. 7. The instrument must not be altered or modified in any way. 8. Maintenance and Inspection: (1) The instrument and parts must undergo regular maintenance inspection at least every 6 months. (2) If stored for extended periods without being used, make sure prior to operation that the instrument is in perfect operating condition. (3) Technical information such as parts list, descriptions, calibration instructions or other information is available for qualified user technical personnel upon request from your Nihon Kohden distributor. 9. When the instrument is used with an electrosurgical instrument, pay careful attention to the application and/or location of electrodes and/or transducers to avoid possible burn to the patient. 10. When the instrument is used with a defibrillator, make sure that the instrument is protected against defibrillator discharge. If not, remove patient cables and/or transducers from the instrument to avoid possible damage. ii Operator's Manual ZM-940PA WARRANTY POLICY Nihon Kohden Corporation (NKC) shall warrant its products against all defects in materials and workmanship for one year from the date of delivery. However, consumable materials such as recording paper, ink, stylus and battery are excluded from the warranty. NKC or its authorized agents will repair or replace any products which prove to be defective during the warranty period, provided these products are used as prescribed by the operating instructions given in the operator’s and service manuals. No other party is authorized to make any warranty or assume liability for NKC’s products. NKC will not recognize any other warranty, either implied or in writing. In addition, service, technical modification or any other product change performed by someone other than NKC or its authorized agents without prior consent of NKC may be cause for voiding this warranty. Defective products or parts must be returned to NKC or its authorized agents, along with an explanation of the failure. Shipping costs must be pre-paid. This warranty does not apply to products that have been modified, disassembled, reinstalled or repaired without Nihon Kohden approval or which have been subjected to neglect or accident, damage due to accident, fire, lightning, vandalism, water or other casualty, improper installation or application, or on which the original identification marks have been removed. In the USA and Canada other warranty policies may apply. CAUTION United States law restricts this device to sale by or on the order of a physician. Equipment Authorization Requirement Operation of this equipment requires the prior coordination with a frequency coordinator designated by FCC for the Wireless Medical Telemetry Service. Operator's Manual ZM-940PA iii EMC RELATED CAUTION This equipment and/or system complies with IEC 60601-2 International Standard for electromagnetic compatibility for medical electrical equipment and/or system. However, an electromagnetic environment that exceeds the limits or levels stipulated in IEC 60601-1-2, can cause harmful interference to the equipment and/or system or cause the equipment and/or system to fail to perform its intended function or degrade its intended performance. Therefore, during the operation of the equipment and/or system, if there is any undesired deviation from its intended operational performance, you must avoid, identify and resolve the adverse electromagnetic effect before continuing to use the equipment and/or system. The following describes some common interference sources and remedial actions: 1. Strong electromagnetic interference from a nearby emitter source such as an authorized radio station or cellular phone: Install the equipment and/or system at another location. Keep the emitter source such as cellular phone away from the equipment and/or system, or turn off the cellular phone. 2. Radio-frequency interference from other equipment through the AC power supply of the equipment and/or system: Identify the cause of this interference and if possible remove this interference source. If this is not possible, use a different power supply. 3. Effect of direct or indirect electrostatic discharge: Make sure all users and patients in contact with the equipment and/or system are free from direct or indirect electrostatic energy before using it. A humid room can help lessen this problem. 4. Electromagnetic interference with any radio wave receiver such as radio or television: If the equipment and/or system interferes with any radio wave receiver, locate the equipment and/or system as far as possible from the radio wave receiver. 5. Interference of lightning When lightning occurs near the location where the equipment and/or system is installed, it may induce an excessive voltage in the equipment and/or system. In such a case, disconnect the AC power cord from the equipment and/or system and operate the equipment and/or system by battery power, or use an uninterruptible power supply. iv Operator's Manual ZM-940PA 6. Use with other equipment When the equipment and/or system is adjacent to or stacked with other equipment, the equipment and/or system may affect the other equipment. Before use, check that the equipment and/or system operates normally with the other equipment. 7. Use of unspecified accessory, transducer and/or cable When an unspecified accessory, transducer and/or cable is connected to this equipment and/or system, it may cause increased electromagnetic emission or decreased electromagnetic immunity. The specified configuration of this equipment and/or system complies with the electromagnetic requirements with the specified configuration. Only use this equipment and/or system with the specified configuration. 8. Use of unspecified configuration When the equipment and/or system is used with the unspecified system configuration different than the configuration of EMC testing, it may cause increased electromagnetic emission or decreased electromagnetic immunity. Only use this equipment and/or system with the specified configuration. 9. Measurement with excessive sensitivity The equipment and/or system is designed to measure bioelectrical signals with a specified sensitivity. If the equipment and/or system is used with excessive sensitivity, artifact may appear by electromagnetic interference and this may cause mis-diagnosis. When unexpected artifact appears, inspect the surrounding electromagnetic conditions and remove this artifact source. If the above suggested remedial actions do not solve the problem, consult your Nihon Kohden distributor or representative for additional suggestions. This equipment complies with International Standard IEC 60601-1-2 (1993) which requires CISPR11, Group 1, Class B. Class B EQUIPMENT is equipment suitable for use in domestic establishments and in establishments directly connected to a low voltage power supply network which supplies buildings used for domestic purposes. Operator's Manual ZM-940PA This page is intentionally left blank. vi Operator's Manual ZM-940PA Conventions Used in this Manual and Instrument Warnings, Cautions and Notes Warnings, cautions and notes are used in this manual to alert or signal the reader to specific information. WARNING A warning alerts the user to the possible injury or death associated with the use or misuse of the instrument. CAUTION A caution alerts the user to possible injury or problems with the instrument associated with its use or misuse such as instrument malfunction, instrument failure, damage to the instrument, or damage to other property. NOTE A note provides specific information, in the form of recommendations, prerequirements, alternative methods or supplemental information. Operator's Manual ZM-940PA vii Explanations of the Symbols in this Manual and Instrument The following symbols found in this manual/instrument bear the respective descriptions as given. On Panel Symbol Description Symbol Defibrillation proof type BF applied part Direct current Defibrillation proof type CF applied part Serial number Attention, consult operator’s manual Year of manufacture Direction for attaching battery cover CSA mark Inside Battery Case Symbol Description Symbol viii Description Description Attention, consult operator’s manual Battery position On LCD Symbol Description Symbol Description Full battery Replace battery NIBP cannot be measured Replace battery Check electrode Operator's Manual ZM-940PA Introduction The ZM-940PA transmitter transmits ECG, respiration, SpO2, NIBP and pulse waveform from a patient to a Nihon Kohden monitor for continuous monitoring. The transmitter can change channels when connected to the QI-901PK channel writer. The front LCD displays SpO2%, NIBP, pulse rate, pulse waveform amplitude, electrode condition mark, battery condition and NIBP measuring mode and interval. Read the operator’s manual for the receiving monitor together with this manual before operation. CAUTION • Do not use the same channel for different patients. Otherwise, two patients’ data will be lost due to mutual modulation interference, or another patient’s data may appear on the receiving monitor screen. • Do not use transmitters of adjacent channels in a hospital. Otherwise, radio waves from one transmitter affect the receiver of the adjacent channel’s transmitter and there may be interference. • Do not use the same transmitter on more than one patient at the same time. Do not connect different sensors on different patients to the same transmitter. NOTE • To prevent interference between channels, assign a channel administrator in the hospital and only he or she should manage channel assignment. • Use Nihon Kohden parts and accessories to assure maximum performance from your instrument. • For stable signal reception, it is recommended to use a diversity antenna system on the receiving monitor. Otherwise, spike noise from transient fading of electric field strength (for example, people moving) may interfere with the transmitter signal and may be mistaken as an arrhythmia on the receiving monitor. • NIBP cannot be measured on a neonate. (ECG, respiration and SpO2 can be monitored on a neonate.) Operator's Manual ZM-940PA Panel Description Front Panel LCD: Displays measuring data, settings and other information. NIBP START/STOP key: Starts/stops NIBP measurement in selected mode. NIBP INTERVAL key: Selects NIBP measurement mode. Refer to the WARNING below. (This symbol is attached to the rear of the battery case cover.) Battery case: Contains three 1.5 V AA batteries. WARNING Close the battery case cover during operation. If the transmitter is used with the battery case cover open, the patient may get an electrical shock when defibrillation is performed, and electrostatic discharge by the patient may intermittently interfere with the waveform or data. Operator's Manual ZM-940PA Rear Panel Lock plate: Fastens the transmitter to an NIBP cuff. Refer to the WARNING below. WARNING This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop using it and contact your Nihon Kohden distributor. If a wet transmitter is used, the patient or anyone in contact with the transmitter may receive an electric shock or patient leakage current over the allowed amount may flow. Operator's Manual ZM-940PA Top Panel Refer to the WARNING on the next page. Refer to the WARNING on the next page. Refer to the symbol page. NIBP socket: Connects the cuff hose. Refer to the symbol page. ECG/impedance RESP socket: Connects the electrode lead for measuring ECG and/or respiration by the impedance method. Bottom Panel Channel number label: Indicates the channel number of the transmitter. Attach the channel number label to the panel of the monitor. Refer to the symbol page. SpO2 socket: Connects the SpO2 probe. Refer to the WARNING on the next page. Operator's Manual ZM-940PA WARNING • Before performing defibrillation, check that the electrode leads and SpO2 probe attached to the patient are properly connected to the transmitter. Touching the metal parts of disconnected leads and probes causes serious electrical shock or injury by discharged energy. • When performing defibrillation, all persons must keep clear of the bed and must not touch the patient, any equipment connected to the patient or the metal parts of leads and probes connected to the patient. Failure to follow this warning may result in serious electrical burn, shock or other injury. • When performing defibrillation, discharge as far as possible from electrodes and medicine on the chest of the patient. If there is a possibility that the defibrillator paddle could touch electrodes and medicine, remove electrodes and medicine from the patient. If the defibrillator contacts these materials, the discharged energy may cause serious electrical burn on the patient. • When using this transmitter with an ESU, the ESU return plate and the electrodes for monitoring must be firmly attached to the patient. If the return plate is not attached correctly, it may burn the patient’s skin where the electrodes are attached. Refer to the instruction manual for the ESU. CAUTION Do not shake or swing the transmitter holding the leads/cables connected to the transmitter. The transmitter may come off and injure someone or damage surrounding instruments. Operator's Manual ZM-940PA LCD LOCK KEYS 10 11 No. 4 5 Name NIBP SYS NIBP DIA NIBP MEAN Check electrode mark Battery replacement mark Message display area Description Displays NIBP systolic value. Displays NIBP diastolic value. Displays NIBP mean value. “CUFF” is displayed with the cuff inflation pressure during measurement. Appears when an electrode or electrode lead becomes detached during ECG measurement. Appears when the batteries are weak. For details, refer to the “Battery Condition Indication” section. Displays messages. When ECG is monitored with 6 electrodes and an electrode or electrode lead is detached, “Check electrode” is indicated as below, depending on the PARAMETER SETUP setting. Refer to the “Changing Parameter Setup Settings” and “ECG and Respiration Monitoring” sections. LEADS OFF DISPLAY set to CHAR ECG ELECTRODE set to AHA LEADS OFF DISPLAY set to CHAR ECG ELECTRODE set to IEC LEADS OFF DISPLAY set to IMAGE Operator's Manual ZM-940PA No. Name 7 NIBP measurement mode NIBP interval bar graph 9 Pulse level bar graph 10 %SpO2 11 PR Operator's Manual ZM-940PA Description Displays NIBP measurement mode. When set to auto mode, the measurement interval is displayed. In auto NIBP measurement, the remaining time from the last measurement to the next measurement is displayed as a bar graph. Displays pulse level in 7 steps. Displays SpO2 data. Displays pulse rate when NIBP or SpO2 is measured. When the SpO2 probe is attached to the patient, the real time pulse rate is displayed. When the SpO2 probe is not attached to the patient, the pulse rate at the end of NIBP measurement is displayed. Notes on Parameter Settings When monitoring NIBP and SpO2, the following setting must be set as indicated in the table to properly transmit the monitoring data to the receiving monitor. Otherwise, SpO2 cannot be monitored properly during NIBP measurement. Some receiving monitors require the software to be upgraded. For details, contact your Nihon Kohden distributor. SpO2 probe attachment site INHIBIT SpO2 DURING NIBP setting Probe attached to the same limb as the cuff ON Probe attached to the limb without cuff* OFF * When the SpO2 probe is attached to the same limb as the NIBP cuff and the cuff is inflated, the SpO2 value becomes unstable and SpO2 or PR alarm may occur. Operator's Manual ZM-940PA Important Safety Information General WARNING • Never use this transmitter in the presence of any flammable anesthetic gas or high concentration oxygen atmosphere. Failure to follow this warning may cause explosion or fire. • Never use this transmitter in a high-pressure oxygen medical care tank. Failure to follow this warning may cause explosion or fire. • Do not take this transmitter into the MRI test room. This transmitter is not designed to be used during MRI tests. Output Signal WARNING Do not use the output signal from the receiving monitor as the synchronization signal for other equipment such as IABP, MRI, echocardiography or defibrillator because there may be time delay between the monitor and the other equipment caused by waveform transmission delay and spike noise may interfere on the output signal and be mistaken as a trigger. Operator's Manual ZM-940PA Preparation Installing (Replacing) Batteries WARNING and CAUTION for Battery Handling WARNING • Do not dispose of the battery in fire because it may explode. • Do not use a disassembled or damaged battery. The contents of the battery are harmful and the battery may catch fire. • If the contents of the battery contact the skin or clothes, immediately wash it thoroughly with water. • Never short-circuit the + and – terminals. The battery may overheat and catch fire. • Take care that the patient does not swallow batteries. CAUTION • Refer to the battery and battery charger manuals for details on handling the batteries. • Do not handle the batteries with wet hands. • When the transmitter is not in use, remove batteries. When batteries are installed, battery power is consumed even if measurement is not performed. Especially, when NiMH batteries remain in the transmitter when the transmitter is not in use, the battery may become unusable from overdischarge and leak liquid which will damage the transmitter. • The battery charger must be used outside the patient environment. Battery Lifetime Use three AA type alkaline dry cell batteries. NiMH rechargeable batteries can also be used. Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 2 days 2 days 2.5 days 1 day 2.5 days 3 days The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO2 is measured on an index finger of a male patient with weight 60 kg. Operation time depends on the thickness of SpO2 probe attachment site. 10 Operator's Manual ZM-940PA NOTE When using rechargeable NiMH batteries, shallow charging/discharging shortens battery capacity. For details, refer to the battery operator’s manual. Installing (Replacing) Batteries CAUTION Battery replacement must be performed by medical staff. When replacing batteries of the transmitter currently used for a patient, disconnect electrode leads from the transmitter before replacing batteries or do not touch the patient during replacement. If electrode leads are attached to the patient and a person replacing batteries touches the patient during battery replacement, patient leakage current over the allowed amount may flow. CAUTION • Replace all batteries at the same time. • Do not use different types of batteries together. NOTE Insert the batteries with the correct polarity (+ and –). Procedure 1. Remove the battery case cover. 2. Operator's Manual ZM-940PA Insert three new or fully charged batteries into the battery case observing the correct polarity. 11 3. Close the cover. NOTE Remove the batteries before disposing of the transmitter. Situations Requiring Battery Replacement Replace the batteries when any of the following occurs. • The transmitter LCD displays the “ ” or “ ”mark. • The transmitter generates a constant alarm (continuous “peep” sound). • The transmitter LCD does not display anything when the power is turned on. • The monitor displays the battery replacement message on the screen. Battery Condition Indication The battery condition is indicated as follows. Indication Condition Fully charged battery No indication 12 Receiving Monitor Batteries are full. There is no indication on the monitor. Batteries are low. Replace batteries. Batteries are low. NIBP cannot be measured. Replace batteries. Message requiring battery replacement is displayed. Dead batteries No signal can be transmitted to the monitor. There is no indication on the monitor. Operator's Manual ZM-940PA Turning the Transmitter On/Off Peep Turning On the Power When the batteries are installed correctly, the power is turned on. A one second “peep” sounds and the startup screen appears. (There is no “peep” sound when there is no battery power.) NOTE Replace the batteries when the LCD displays the “ ” or “ ”mark. Turning Off the Power To turn off the power, remove batteries. Check Items Before Use Before turning on the transmitter power, check the following to confirm that the transmitter can be used in normal and safe condition. Appearance • There are no damaged or dirty parts on the outside of the transmitter (LCD, keys, sockets, battery case cover, battery case, lock plate, etc.). • The transmitter is completely dry. • The electrode lead, SpO2 probe and NIBP cuff are not broken. • There are no damaged or dirty parts on the disposable SpO2 probe, disposable electrodes or disposable NIBP cuff. Batteries • The battery polarity is correct. • The battery case spring is firmly fixed and the battery is not loose. • The battery case cover is firmly closed. Channel Setting • The transmitter channel corresponds to those of the receiving monitor. • There is no transmitter in the surrounding area with the same channel. Operator's Manual ZM-940PA 13 Check Items After Power On After turning on the power, check the following. Power On • The transmitter generates about a one second “peep” sound and the startup screen appears. • The transmitter does not generate a continuous “peep” sound. • The transmitter does not give excessive heat. • The transmitter LCD displays a “ ” mark. • The transmitter does not interfere with the operation of other medical instruments in use. Basic Operation • The “signal loss” message is not displayed on the receiving monitor when the transmitter is inside the receiving range of the monitor. • The battery replacement message is not displayed on the monitor. • The keys on the transmitter function properly. • The LCD brightness is appropriate. To adjust brightness, refer to the “Changing System Setup Settings” section. Check Items After Use To use the transmitter in safe and optimum condition for next time, check the following. Before Turning Power Off • Temporarily changed settings are changed back to the previous settings. • There was no malfunction on the transmitter. Storage • ECG electrode leads, SpO2 probe and NIBP cuff are cleaned and disinfected. • When the transmitter gets wet, liquid is wiped off and the transmitter is thoroughly dried. • There are enough consumables, such as disposable electrodes. • The transmitter power is turned off by removing batteries from the transmitter. • Dead batteries are disposed of properly. 14 Operator's Manual ZM-940PA Changing the Transmitter Channel The channel of the transmitter can be changed. The optional QI-901PK Channel Writer is required. WARNING The following action must be taken to properly receive the transmitter signal of the correct patient on the receiving instrument. Otherwise, there may be signal loss or signals may mix causing a serious accident, such as monitoring a different patient. • Assign a channel administrator in the hospital and only he or she should manage channel assignment on his or her responsibility. • The channel administrator must manage the channels in the facility so that there is no signal interference. • When the transmitter channel is changed, the channel administrator must check that the channel on the receiving monitor is also changed and the signal is properly received. • The channel administrator must replace the channel number label on the transmitter with the new one after changing the channel. NOTE The software version of the QI-901PK channel writer must be 02-01 or later to change the channel on the ZM-940PA transmitter. To check the transmitter channel, refer to “CHANNEL” in the “Changing System Setup Settings” section. Operator's Manual ZM-940PA 15 Changing Parameter Setup Settings The initial settings on the PARAMETER SETUP screen must be changed before monitoring. Changing these settings during monitoring interrupts monitoring. Parameter Setup Setting List The factory default settings are underlined. Setting Item SELECTABLE INTERVALS Description Select the NIBP measurement modes for the mode selection. INITIAL INTERVAL Select the initial NIBP measurement mode at power on. INITIAL CUFF PRESS Select the NIBP cuff inflation pressure. NIBP MODE AFTER STAT START/FINISH SOUND OLD NIBP DATA AFTER INHIBIT SpO2 DURING NIBP 2ND PARAMETER LEADS OFF DISPLAY ECG ELECTRODE 16 Select the NIBP measurement mode after completing STAT measurement. Turn ON or OFF the sound for NIBP measurement start/finish. Select whether to hide or dim the NIBP data after measurement and how long to wait after measurement to dim or hide it. Turn SpO2 monitoring on or off during NIBP measurement. Set SpO2 and PR display order. Select the mode for displaying electrode off. This setting is only available when ECG is monitored with 6 electrodes. Select the electrode lead type. This setting is only available when CHAR is selected for LEADS OFF DISPLAY. Settings STAT, 5, 10, 15, 30, 60, 120, 240 MAN., 5 min, 10 min, 15 min, 30 min, 60 min, 120 min, 240 min 120 mmHg, 150 mmHg, 180 mmHg, 210 mmHg, 240 mmHg MAN., 5 min, 10 min, 15 min, 30 min ON, OFF/ON, OFF DATA: HIDE, DIM AFTER: 5 min, 10 min, 30 min ON, OFF SpO2, PR CHAR, IMAGE IEC, AHA Operator's Manual ZM-940PA Displaying the PARAMETER SETUP Screen 1. Remove one battery. 2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 3. Press the NIBP START/STOP key to enter the PARAMETER SETUP screen. When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the startup screen appears, then the monitoring screen appears. 4. To select or change a setting, press the NIBP START/STOP key. To move the cursor, press the NIBP INTERVAL key. Selects or changes setting Moves cursor When the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the SETUP screen appears. Operator's Manual ZM-940PA 17 Changing Settings SELECTABLE INTERVALS During monitoring, when the NIBP INTERVAL key is pressed, the measurement mode changes according to the modes selected in this item. MANUAL mode is already selected for the mode selection. 1. Press the NIBP INTERVAL key to move the cursor to the desired mode. 2. Press the NIBP START/STOP key to select or unselect the mode. Selectable modes are: STAT, 5, 10, 15, 30, 60, 120 and 240 min. INITIAL INTERVAL Select the initial NIBP measurement mode at power on. 1. Press the NIBP INTERVAL key to move the cursor to “INITIAL INTERVAL”. 2. Press the NIBP START/STOP key to select the mode. Selectable modes are the modes selected for “SELECTABLE INTERVALS” and “MAN.” (MANUAL). 1. Press the NIBP INTERVAL key to move the cursor to “INITIAL CUFF PRESS”. 2. Press the NIBP START/STOP key to select the inflation pressure from 120, 150, 180, 210 and 240 mmHg. INITIAL CUFF PRESS Select the NIBP cuff inflation pressure. 18 Operator's Manual ZM-940PA NIBP MODE AFTER STAT Select the NIBP measurement mode after completing the STAT measurement. 1. Press the NIBP INTERVAL key to move the cursor to “NIBP MODE AFTER STAT”. 2. Press the NIBP START/STOP key to select the mode. The selected mode is automatically selected for “SELECTABLE INTERVALS” as well. START/FINISH SOUND Turn on or off the sound for NIBP measurement start and finish. Start sound End sound 1. Press the NIBP INTERVAL key to move the cursor to “START/FINISH SOUND”. 2. Press the NIBP START/STOP key to turn ON or OFF. OLD NIBP DATA/AFTER Select whether to dim or hide the NIBP data after measurement and how long to wait after NIBP measurement to dim or hide it. 1. Press the NIBP INTERVAL key to move the cursor to “OLD NIBP DATA/AFTER”. 2. DATA: AFTER: Press the NIBP START/STOP key to select the setting. DIM NIBP data is dimmed after the “AFTER” interval. HIDE NIBP data is hidden after the “AFTER” interval. “– – –” is displayed on the screen. Select the interval after NIBP measurement to dim or hide. Dimmed Operator's Manual ZM-940PA Hidden 19 INHIBIT SpO2 DURING NIBP Set whether or not to monitor SpO2 during NIBP measurement. When the SpO2 probe is attached to the same limb as the NIBP cuff and this setting is set to OFF, the pulse may become unstable and SpO2 or PR alarm may occur. It is recommended to set this setting to ON so that SpO2 is not measured during NIBP measurement. When the SpO2 probe is attached to the other limb from the NIBP cuff, this setting can be set to OFF. NOTE When this “INHIBIT SpO2 DURING NIBP” is set to OFF, refer to the “Monitoring SpO2 during NIBP Measurement” section. 1. Press the NIBP INTERVAL key to move the cursor to “INHIBIT SpO2 DURING NIBP”. 2. Press the NIBP START/STOP key to select “ON” or “OFF”. ON: Stops SpO2 monitoring during NIBP measurement. OFF: SpO2 is monitored during NIBP measurement. 2ND PARAMETER Set the display order of SpO2 and PR. When set to SpO2 20 1. Press the NIBP INTERVAL key to move the cursor to “2ND PARAMETER”. 2. Press the NIBP START/STOP key to select “SpO2” or “PR”. When set to PR Operator's Manual ZM-940PA LEADS OFF DISPLAY Select the mode for displaying electrode off. This setting is only available when ECG is monitored with 6 electrodes. 1. Press the NIBP INTERVAL key to move the cursor to “LEADS OFF DISPLAY”. 2. Press the NIBP START/STOP key to select “CHAR” or “IMAGE”. When set to IMAGE When set to CHAR ECG ELECTRODE Select the electrode lead type. This setting is only available when “CHAR” is selected for LEADS OFF DISPLAY. 1. Press the NIBP INTERVAL key to move the cursor to “ECG ELECTRODE”. 2. Press the NIBP START/STOP key to select “IEC” or “AHA”. AHA: IEC: Operator's Manual ZM-940PA RA, LA, LL, Va, Vb R, L, F, Ca, Cb 21 Changing System Setup Settings NOTE Changing System Setup settings must be done only by a qualified personnel. System Setup Setting List The factory default settings are underlined. Setting Item CHANNEL PRESSURE UNIT LANGUAGE BRIGHTNESS SYSTEM INITIALIZE Description Displays the transmitter channel. Select the units for NIBP. Select the language for screen display. Select the LCD brightness. Initializes all settings to the factory default settings. Settings mmHg, kPa JPN, ENG 1, 2, 3, 4 Displaying the SYSTEM SETUP Screen 1. Remove one battery. 2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 3. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”. 4. Press the NIBP START/STOP key to enter the SYSTEM SETUP screen. When the cursor is moved to “EXIT” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the startup screen appears, then the monitoring screen appears. 22 Operator's Manual ZM-940PA 5. To select or change a setting, press the NIBP START/STOP key. To move the cursor, press the NIBP INTERVAL key. Selects or changes setting Moves cursor When the cursor is moved to “RETURN” by pressing the NIBP INTERVAL key and the NIBP START/STOP key is pressed, the SETUP screen appears. Changing Settings CHANNEL The channel of this transmitter is displayed. Channel of this transmitter PRESSURE UNIT Select the unit for NIBP. Operator's Manual ZM-940PA 1. Press the NIBP INTERVAL key to move the cursor to “PRESSURE UNIT”. 2. Press the NIBP START/STOP key to select “mmHg” or “kPa”. 23 LANGUAGE Select the language for screen display. 1. Press the NIBP INTERVAL key to move the cursor to “LANGUAGE”. 2. Press the NIBP START/STOP key to select the language. 1. Press the NIBP INTERVAL key to move the cursor to “BRIGHTNESS”. 2. Press the NIBP START/STOP key to select the LCD brightness from 1 to 4. Light .............................. Dark BRIGHTNESS Select the LCD brightness. SYSTEM INITIALIZE Do the following procedure to initialize the settings to the factory default settings. 1. Press the NIBP INTERVAL key to move the cursor to “SYSTEM INITIALIZE”. 2. Press the NIBP START/STOP key. The “EXECUTE” message appears. 3. Press the NIBP START/STOP key to initialize the settings to the factory default settings. 24 Operator's Manual ZM-940PA Attaching NIBP Cuff, Electrodes and SpO2 Probe to the Patient The transmitter can be attached to an arm of the patient or placed on the bedside. The required length of the electrode leads and SpO2 probe cable depends on how the transmitter is to be attached to the patient. NOTE Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful when reading SpO2 values. When monitoring SpO2 is important, attach the probe to the limb to which the NIBP cuff or catheter is not attached. Attachment Examples When transmitter is attached on an arm When transmitter is placed on a bedside NOTE When placing the transmitter on a bedside, place it on a stable and flat place. If the transmitter falls off, it may be damaged. Operator's Manual ZM-940PA 25 Attaching the NIBP Cuff Selecting the NIBP Cuff Select the NIBP cuff appropriate for the patient. NOTE NIBP cannot be measured on neonates using this transmitter. Reusable Cuffs When attaching the transmitter to the patient arm, a special NIBP cuff is required. An optional YN-990P extension hose (1.5 m) is available to extend the length between the NIBP socket on the transmitter and NIBP cuff (e.g. when not attaching the transmitter to the patient arm and placing the transmitter on a bedside). Reusable cuff Standard For adult Large Model YP-943P Width (cm) 13 Air hose length (cm) 15 YP-944P 15 15 Air hose Width When not attaching the transmitter to the patient arm, the following cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required. Reusable cuff For infants Model YP-960T Width (cm) Small YP-961T Standard YP-962T 10 Standard YP-963T 13 Large YP-964T 15 For children For adults Air hose length (cm) 15 Width Air hose 26 Operator's Manual ZM-940PA Disposable Cuffs CAUTION The disposable cuffs are not sterilized. If necessary, sterilize the disposable cuffs using glutaraldehyde solution by following the instructions for the glutaraldehyde. When not attaching the transmitter to the patient arm, the following disposable cuffs can be used. To use these cuffs, an optional YN-990P extension hose (1.5 m) is required. Reusable cuff For infants Model YP-910P Width (cm) For children YP-912P For adults Small YP-913P 12 Standard YP-914P 14 Large YP-915P 16 Air hose length (cm) 20 Width Air hose Extension Hose CAUTION When using an extension hose, check that the extension hose is not bent or squeezed. Otherwise, the cuff may not inflate or deflate. If the cuff cannot deflate, it may cause congestion on the patient at the cuff attachment site. YN-990P extension hose, 150 cm Operator's Manual ZM-940PA 27 Reference for selecting a cuff The AHA (American Heart Association) recommends that the cuff width be 40% of the circumference of the upper arm. Refer to the following graph and select the cuff which suits the patient’s arm. NOTE • If a range of arm circumference appropriate for the cuff is prescribed, use a cuff within that range. • To obtain accurate measured values, select a wide cuff which can be attached to the upper arm. Measuring with a very narrow cuff may result in measured values higher than the actual values. • The YP-943P NIBP cuff is for standard size adult. Do not use this cuff when it does not fit the patient. Cuff Width and Arm Circumference Reusable Cuffs Adults large YP-944P (cuff for transmitter) YP-964T Cuff width (cm) 15 Adults standard YP-943P (cuff for transmitter) YP-963T 10 Children standard YP-962T Children small YP-961T Infants YP-960T 10 20 30 40 50 60 Arm circumference (cm) Disposable Cuffs Cuff width (cm) 20 Adults large YP-915P 15 Adults standard YP-914P Adults small YP-913P 10 Children standard YP-912P Infants YP-910P 28 10 20 30 40 50 60 Arm circumference (cm) Operator's Manual ZM-940PA Connecting the NIBP Cuff to the Transmitter When Using YP-943P/944P NIBP Cuff To attach the YP-943P/944P NIBP cuff to the transmitter, the lock plate is required. YP-943P/944P NIBP cuff Front cover Air hose D ring Belt Belt for the strap Lock plate pocket Front cover open Lock plate Top tab For attaching the NIBP cuff to the transmitter NOTE Do not roll up or put weight on the cuff with the lock plate attached to it. Otherwise, the lock plate may break. Bottom tab Operator's Manual ZM-940PA 29 1. Remove the lock plate from the transmitter. 2. Insert the lock plate into the lock plate pocket on the NIBP cuff. 3. Attach the transmitter to the lock plate by inserting the tabs on the lock plate into the slots on the transmitter. 4. Cover the transmitter with the front cover of the NIBP cuff. 5. Connect the air hose to the NIBP socket on the transmitter. Turn the cuff connector joint until it clicks. 30 Operator's Manual ZM-940PA When Using YP-960T series or YP-910P series NIBP Cuff To use these NIBP cuffs, an optional YN-990P extension hose (1.5 m) is required. NOTE Connect the joints properly. If there is an air leak, NIBP cannot be measured properly. 1. Connect the NIBP cuff to the extension hose. 2. Connect the other end of the extension hose to the NIBP socket on the transmitter. Turn the joint clockwise until it clicks. To disconnect the cuff from the transmitter, turn the hose joint counterclockwise. Attaching the NIBP Cuff to the Patient WARNING Be careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where the cuff was attached. CAUTION • Do not wrap the cuff on an arm or thigh which is used for injection. NIBP measurement on an arm or thigh which is used for injection may cause a reflux of blood and stop injection. • Do not wrap the cuff too tight. It may cause poor blood circulation and congestion. If the cuff is wrapped too loosely, the NIBP value may be increased. • If the skin gets irritated or redness appears on the skin from the cuff, change the attachment site or stop using the cuff. Operator's Manual ZM-940PA 31 • NIBP and SpO2 can be measured on the same limb, but the SpO2 monitoring may not be accurate during NIBP measurement. Be careful when reading the SpO2 values.* • Do not reuse disposable cuffs. * Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values. NOTE • Measuring NIBP at a site other than the upper arm gives different values from those measured at the upper arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm. • To accurately detect the pulsatile flow of the artery, the cuff should be wrapped around a bare upper arm. • Do not use an abnormal cuff. The cuff deteriorates from use and cleaning. Before use, check the cuff and confirm that there is no flaw, crack or hole in it. Be careful not to damage the inflation bag. If the inflation bag has a hole or a flaw, it may burst during use. Dispose of an abnormal cuff and replace it with a new one. • Refer to the NIBP cuff manual for details. Cuff Position When placing the transmitter on a bed, make sure that the hose is not bent. Place the cuffed upper arm (brachium) at the same height as the patient’s heart. If the cuff is not at the same level as the heart, the weight of the blood affects the blood pressure reading. The pressure difference per unit height is 0.7 mmHg/cm. The blood pressure reading decreases when the arm is higher than the heart and increases when lower. Heart The best measuring condition is when the patient is lying on his/her back with arms and legs relaxed. If the cuff position cannot be on the same level as the heart, the displayed blood pressure reading must be mathematically adjusted. 32 Operator's Manual ZM-940PA Using the YP-943P/944P NIBP Cuff 1. Attach the NIBP cuff to the transmitter. Refer to the “Connecting the NIBP Cuff to the Transmitter” section. 2. Insert the end of the cuff into the belt and then through the D ring as shown at left. 3. Fold back the cuff at the D ring and fasten it using the velcro tape. Belt D ring End of cuff Make sure that the cuff is not attached on a joint. NOTE The cuff must not wrap around the elbow. Operator's Manual ZM-940PA 33 Attaching the Strap to the Transmitter NOTE • Use the strap to prevent the transmitter from falling. • Do not attach the clip to hard objects such as thick cloth or zipper. It will break the clip. Attach a strap provided with the transmitter to the NIBP cuff and patient clothes. To open the clip, firmly pull out the tab in direction of the arrow. To adjust the strap length, push down the tab on the adjuster and slide. Belt for the strap on the NIBP cuff 1. 34 Adjust the length of the strap. 2. Clip one end of the strap to the belt for the strap on the NIBP cuff. 3. Clip the other end of the strap to the patient’s clothes as shown left. Operator's Manual ZM-940PA Using the YP-960T series Reusable Cuffs or YP-910P series Disposable Cuffs ARTERY 1. Put the cuff on the upper arm so that the mark of “ARTERY ” aligns with the artery of the patient. 2. Wrap the cuff so that “INDEX RANGE ”. within the “ ” comes If “Index ” is not within the “ ”, change the cuff size. RANGE RANGE Attaching Electrodes Selecting Electrode Lead CAUTION Use only Nihon Kohden specified electrode leads. With electrodes and electrode leads other than specified ones, the “CHECK ELECTRODE” message appears and monitoring may stop. The following electrode leads can be used on the transmitter (option). BR-903PA, 3 electrodes, clip type BR-913PA, 3 electrodes, snap type Operator's Manual ZM-940PA BR-906PA, 6 electrodes, clip type BR-916PA, 6 electrodes, snap type 35 Connecting the Electrode Lead to the Transmitter Connect the electrode lead to the ECG/RESP socket on the transmitter. When the transmitter is attached on an arm CAUTION Hold the connector of the electrode lead when connecting/disconnecting the electrode lead. If you disconnect the electrode lead by pulling the lead, it damages the electrode lead. Selecting the Electrode Position Follow the physician’s instructions for electrode placement when available. For ECG monitoring, electrodes are attached only on the chest to allow patient movement and obtain continuous stable ECG. Following leads are examples. When also monitoring respiration, refer to the “Electrode Position for Respiration Monitoring” section. NOTE The optimum electrode positions for ECG measurement of a patient are not always optimum for respiration measurement of the patient. Select positions suitable for both ECG and respiration measurements, or positions which have priority for one measurement. 36 Operator's Manual ZM-940PA Six Electrodes The 6-electrode method with lead II and lead V5 is effective for monitoring myocardial ischemia. You can improve monitoring accuracy considerably by adding lead V4 to this combination. Va and Vb can be at any position of the standard 12 leads V1 to V6, but V4 and V5 are most appropriate for myocardial ischemic monitoring. LA/L RA/R Va/Ca Vb/Cb RL/RF LL/F Electrode Position Symbol Lead Color AHA IEC AHA IEC Left infraclavicular fossa LA Black Yellow Right infraclavicular fossa RA White Red Below lowest rib on the left anterior axillary line LL Red Green RL RF Green Black Va Ca Vb Cb Brownblue Brownorange Whitebrown Whiteblack Right anterior axillary line at the same level as LL/F Fifth intercostal space on the left midclavicular line. (V4 position of standard 12 leads) Left anterior axillary line at the same level as Va. (V5 position of standard 12 leads) Operator's Manual ZM-940PA 37 Lead Position Standard limb leads Lead I RA Lead II LA Lead III RA LL N (RL) Monopolar limb leads aVR lead N (RL) aVL lead aVF lead RA LA RA LA N (RL) N (RL) LA LL LL LL LA LL LL N (RL) RA RA LA N (RL) Monopolar chest leads V1 to V6 leads to RA LA LL N (RL) 38 Operator's Manual ZM-940PA Three Electrodes • Lead MII, which is similar to standard lead II, used when ECG measurement has priority Electrode Position Left infraclavicular fossa Right infraclavicular fossa Below lowest rib on the left anterior axillary line • Lead MI, which is similar to standard lead I Change F/LL and L/LA of the lead MII. Symbol AHA IEC LA RA LL Lead Color AHA IEC Black Yellow White Red Red Green • Lead MIII, which is similar to standard lead III. Change R/RA and L/LA of the lead MII. If the electrode position shown above is not available due to chest surgery, attach the electrodes to the root of the limbs or below the clavicles for stable ECG monitoring. Operator's Manual ZM-940PA 39 Attaching Electrodes to the Patient and Connecting the Electrode Leads to Disposable Electrodes Prepare the Patient Skin Shave off excessive body hair. To reduce skin impedance, clean the electrode site with cream or with a cotton pad moistened with alcohol. Thoroughly dry the skin with a clean cotton pad. NOTE • For a patient with frequent body movement, rub the sites with Skinpure skin preparation gel. However, do not use Skinpure skin preparation gel on sensitive skin. • Do not place electrodes on a wound or on an inflamed, wrinkled or uneven skin surface. Attaching Electrodes to the Patient CAUTION Do not reuse disposable products. NOTE • To maintain good contact between the electrode and skin, check that the paste of the disposable electrode is not dry. • When contact between the disposable electrode and skin becomes poor, replace electrodes with new ones immediately. Otherwise, contact impedance between the skin and the electrode increases and the correct ECG cannot be obtained. Refer to the electrode operator’s manual for details. 40 1. Carefully remove the backing paper from the electrode. Avoid touching the adhesive surface. 2. Place the electrode on the previously cleaned skin. Pay attention to the electrode lead color and symbol. 3. Clip the electrode lead to the electrode. 4. Fasten the electrode lead wire with surgical tape with an extra length of wire between the tape and the electrode. This lessens the movement of electrode leads by body movement and helps stable monitoring. Operator's Manual ZM-940PA Electrode Position for Respiration Monitoring Place the R/RA and F/LL electrodes so that the lungs are between the electrodes. NOTE The optimum electrode positions for ECG measurement of a patient are not always optimum for respiration measurement of the patient. Select positions suitable for both ECG and respiration measurements, or positions which have priority for one measurement. Electrode Position Examples NOTE The following examples are when monitoring with 3 electrodes. ECG cannot be monitored correctly when electrodes are attached as the following examples when monitoring with 6 electrodes. Position 1 In this position, respiration measurement is available; however, there is a difference in amplitude between different patients. R or RA Right infraclavicular fossa F or LL Fifth intercostal space on the left midclavicular line, V4 Position 2 In this position, the waveform amplitude is usually large and the ECG lead is similar to Lead MII. This position can be generally recommended. R or RA Right infraclavicular fossa Operator's Manual ZM-940PA F or LL Fifth intercostal space on the left midaxillary line, V6 41 Position 3 In this position, the respiration waveform is optimum, but the ECG lead is unusual. R or RA Right midaxillary at the horizontal level of V4 F or LL Fifth intercostal space on the left midaxillary line, V6 Position 4 In this position, the respiration measurement is influenced by the impedance variation of the abdomen, so the cardiac pulse wave included in the respiration wave is reduced. Note that the waveform is inverted in phase compared with the chest movement (the waveform goes down during inspiration). It is difficult to measure the ECG at the same time. R or RA Lowest rib on the right anterior axillary line 42 F or LL Lowest rib on the left anterior axillary line Operator's Manual ZM-940PA Attaching the SpO2 Probe Selecting the SpO2 Probe Select an appropriate probe for the patient. CAUTION • Use Nihon Kohden specified SpO2 probe to assure maximum performance from your instrument. • Do not use damaged or disassembled probe. It causes incorrect measurement and may hurt the patient. Reusable Probes When using a TL-201T finger probe, choose the appropriate cable length for attachment. Probe Cable Length Patient Attachment site Finger probe TL-201T Adult or children Finger 20 kg or more 0.6 m 1.6 m Multi-site probe TL-220T Operator's Manual ZM-940PA Attachment tape Adult or Infant 3 kg or more Finger or toe Neonate 3 kg or less Instep and sole 43 Disposable Probes CAUTION • Use the disposable probe only for one patient. Never reuse the disposable probe for another patient because it causes cross infection. • Disposable probes are not sterilized. Probe Patient Adult 30 kg or more Attachment site Finger or toe TL-252T Child 3 to 40 kg Finger or toe TL-253T Neonate 3 kg or less Instep and sole Multi-site Y probe TL-260T Low birth weight infant 1 kg or less Neonate or Child 3 kg or more Neonate 3 kg or less Adult 50 kg or more Instep and sole Finger or toe Neonate 3 kg or less Instep and sole Child or Adult 15 to 50 kg Finger Infant 3 to 15 kg Toe TL-251T Attachment tape TL-051S/052S 40 mm Cable length TL-051S: 80 cm TL-052S: 160 cm TL-061S/062S 35 mm Cable length TL-061S: 80 cm TL-062S: 160 cm 44 Instep and sole Finger Attachment tape S Attachment tape S Attachment tape L Operator's Manual ZM-940PA Model TL-271T Patient Adult 30 kg or more TL-272T Child 10 to 50 kg TL-273T Neonate 3 kg or less Attachment site Finger or toe Instep Adult 40 kg or more TL-274T Operator's Manual ZM-940PA Infant 3 to 20 kg Finger or toe 45 Connecting the SpO2 Probe to the Transmitter Connect the probe to the SpO2 socket on the transmitter. When the transmitter is attached on an arm CAUTION Hold the connector when connecting/disconnecting the probe. If you disconnect the SpO2 probe by pulling the cable, it damages the cable. Attaching the Probe to the Patient Attach the probe to the patient by referring to the probe’s manual. Make sure that the light emitter and photo detector of the probe face each other at the attachment site. WARNING • When using a TL-201T finger probe, do not fasten it to a finger by wrapping the probe to the site with some tape. It may cause poor blood circulation, congestion, pressure necrosis or burn. • When using probes other than a TL-201T finger probe, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for shortterm monitoring, there may be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation. 46 Operator's Manual ZM-940PA • Check the circulation condition by observing the skin color of the measuring site and the pulse waveform. Change the measuring site every 8 hours for disposable probes and every 4 hours for reusable probes. The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree. • A patient with a fever • A patient with a peripheral circulation insufficiency • Neonate or low birth weight infant with delicate skin CAUTION • If the attachment site is dirty with blood, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases and the measured data may be incorrect or measurement cannot be performed. • If the skin gets irritated or redness appears on the skin from the probe, change the attachment site or stop using the probe. • When the probe is attached on an appropriate site with sufficient circulation, but the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one. • Do not use a probe that is deteriorated by aging. Accurate measurement cannot be performed. • When using probes other than a TL-201T finger probe on a neonate, be careful when removing the adhesive tape from neonatal skin. • When removing a probe taped to the skin, do not pull the cable. Otherwise the cable may break. • When removing the probe from the attachment tape, do not pull the sensor cable. Otherwise the cable may get damaged. • Before using the TL-260T multi-site Y probe, be sure to attach the probe to the sponge attachment tape S or L. Do not use the probe without the sponge attachment tape attached. It causes incorrect measurement and may damage the attachment site on the skin. • When fixing the TL-260T multi-site Y probe with the sponge attachment tape, confirm that the adhesive part of the tape is not on the skin. The adhesive may cause oversensitive symptoms on the skin such as redness or itch. If the adhesive touches the skin, remove it carefully and slowly because neonatal skin is very delicate. • Do not use a dirty sponge attachment tape. The measurement value may be incorrect. • Refer to the probe instruction manual for details. Operator's Manual ZM-940PA 47 Locking the Keys on the Transmitter To prevent the patient from pressing the keys on the transmitter during monitoring, you can lock the NIBP START/STOP and NIBP INTERVAL keys. 1. Press the NIBP INTERVAL key for about 3 seconds. 2. A “pip, pip” sounds and the “LOCK KEYS” message is displayed on the LCD. Pip, pip LOCK KEYS When the NIBP START/STOP key or NIBP INTERVAL key is pressed while the keys are locked, the “PRESS INT. KEY 3S TO UNLOCK” message appears. To unlock the keys: 1. Press the NIBP INTERVAL key for about 3 seconds. 2. 48 A “pip, pip” sounds and the keys are unlocked. The “UNLOCK KEYS” message appears and the keys are unlocked. Operator's Manual ZM-940PA Monitoring When preparation is done, monitoring starts. NIBP Oscillometric Method NIBP is measured from the change in amplitude pattern of pulsatile oscillation in cuff pressure as the cuff pressure is reduced from above systolic to below diastolic pressure. The occlusiveoscillometry method uses this to determine the systolic, diastolic and mean arterial pressure. NIBP Monitoring Selecting the Initial Cuff Inflation Pressure The initial cuff inflation pressure can be changed on the PARAMETER SETUP screen. The default setting is 180 mmHg. To change the setting, refer to the “Changing Parameter Setup Settings” section. Selecting the Measurement Mode and Interval Measurement Modes There are three measurement modes: manual, auto and STAT. The selected mode or interval is displayed at the lower right of the screen. The measurement mode and interval can be changed by pressing the NIBP INTERVAL key. When the key is pressed, the measurement mode changes according to the modes selected at “SELECTABLE INTERVALS” on the PARAMETER SETUP screen. MANUAL mode is already selected for the mode selection. To select the modes for the mode selection, refer to the “Changing Parameter Setup Settings” section. Manual Measurement In Manual mode, a single NIBP measurement is performed when the NIBP START/STOP key is pressed. STAT (Continuous) Measurement In STAT mode, measurement is continuously repeated for 15 minutes after the NIBP START/ STOP key is pressed. When the STAT measurement for 15 minutes is completed, the measurement mode automatically changes to the Manual mode or Auto mode of selected interval depending on the “NIBP MODE Operator's Manual ZM-940PA 49 AFTER STAT” setting on the PARAMETER SETUP screen. The default setting is Manual mode. Refer to the “Changing Parameter Setup Settings” section. The STAT measurement completes within 15 minutes. When more than 12 minutes elapse from the start of measurement, there will be no more measurement performed and the measurement mode changes to the mode selected for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen. Auto Measurement In Auto mode, measurement is performed automatically at the preset time intervals. In Auto mode, a single measurement can be performed by pressing the NIBP START/STOP key between auto measurements. Measuring NIBP WARNING • Be careful when measuring NIBP on a patient with known bleeding disorders or coagulation. After NIBP measurement, there may be dot hemorrhage, or circulatory disorder by thrombus where cuff is attached. • NIBP measurement may be incorrect in the following cases. • When using an electrical surgery unit. • When there is body movement. • When the pulse wave is small (insufficient peripheral circulation). • Too many arrhythmia. • When there is vibration. • When there is a rapid blood pressure change. • During CPR. • When performing NIBP measurements in STAT mode or 5 minute intervals, periodically remove the cuff from the patient for ventilation. Otherwise, the skin temperature may increase at the cuff attachment site by 2 or 3°C (4 or 5°F). When measuring a patient with a fever or peripheral circulation insufficiency, it may cause a burn. CAUTION When performing NIBP measurement repeatedly, have a rest between measurements to recover adequate circulation. 50 Operator's Manual ZM-940PA NOTE • When measuring patients who are conscious, help the patient to relax. Measurement may not be accurate if the patient’s arm is tense or if the patient talks. • The data for measurement on a leg tends to be higher than measurement on the arm. When making diagnosis based on the NIBP values, measure NIBP on an upper arm. • Do not apply pressure to the cuff or air hose. NIBP may not be measured correctly because of noise or NIBP measurement may stop due to the NIBP safety circuit. • When the transmitter is attached to the patient arm and the NIBP measurement is performed when moving, tell the patient to relax and keep quiet. Otherwise, measurement may be stopped or remeasurement is repeated due to body movement. • If there is an abnormal noise generated during measurement, stop using the transmitter and contact your Nihon Kohden distributor. • Do not measure NIBP of a patient on whom an IABP is being used. Measurement may be incorrect due to the mixing of the patient’s own pulse and IABP pulse. • NIBP cannot be measured on a neonate using this transmitter. 1. Select the measurement mode by pressing the NIBP INTERVAL key. 2. Press the NIBP START/STOP key to perform measurement. Operator's Manual ZM-940PA 51 The cuff is inflated and the inflation pressure is displayed on the screen. Inflation pressure In manual mode: Measurement is performed once. In STAT mode: Measurement is performed repeatedly for 15 minutes. In auto mode: The first measurement is performed when the NIBP START/STOP key is pressed. The second measurement is performed when the current time in the transmitter reaches the selected time interval. To stop measurement during measurement, press the NIBP START/STOP key again. In STAT mode, after completing the STAT measurement, the measurement mode changes to the mode set for “NIBP MODE AFTER STAT” on the PARAMETER SETUP screen. In auto mode, to stop measurement in auto mode, change the mode to manual. To cancel one measurement, press the NIBP START/STOP key during measurement. After the measurement is complete, the measured data is displayed on the screen and is transmitted to the monitor. When SpO2 is not monitored, the pulse rate at the end of NIBP measurement is displayed. During auto mode measurement, the measurement mode can be changed. During the interval, press the NIBP INTERVAL key to change the mode. When “MANUAL” is displayed for more than one second, the measurement in auto mode is stopped. A buzzer can be set to sound at the start and end of NIBP measurement. Refer to the “Changing Parameter Setup Settings” section. 52 Operator's Manual ZM-940PA Data Display After NIBP Measurement When the time set at “OLD NIBP DATA” on the PARAMETER SETUP screen elapses after the last measurement, the NIBP data is dimmed or hidden. Whether to dim or hide the old data can also be selected at “OLD NIBP DATA”. Refer to the “Changing Parameter Setup Settings” section. Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as the NIBP, be careful when reading SpO2 values. ECG and Respiration Monitoring When the electrodes are attached and the ECG leads are connected to the electrodes, heart rate, ECG, respiration rate and respiration waveform appear on the monitor. When 6 leads are used on this transmitter, up to 8 lead (I, II, III, aVR, aVL, aVF, Va and Vb) of ECG waveforms can be displayed on the receiving monitor. The heart rate is also measured. When 3 leads are used, one channel ECG waveform of lead II can be displayed on the receiving monitor. Refer to the operator’s manual of the monitor for details. Respiration is monitored by measuring changes in impedance between the RA and LL ECG electrodes. This transmitter sends the changes in impedance to the monitor as a respiration waveform. The monitor displays the respiration waveform and calculates respiration rate. Refer to the operator’s manual of the monitor for details. WARNING Interaction Between Minute Ventilation Rate-Adaptive Pacemakers and Cardiac monitoring and Diagnostic Equipment* The bioelectric impedance measurement sensor of a minute ventilation rateadaptive implantable pacemaker may be affected by the transmitter which is connected to the same patient. If this occurs, the pacemaker may pace at its maximum rate and the transmitter may give incorrect data to the monitor. If this occurs, disconnect the electrode leads from the patient or change the setting on Operator's Manual ZM-940PA 53 the pacemaker by referring to the pacemaker’s manual. For more details, contact your pacemaker distributor or Nihon Kohden distributor. * Minute ventilation is sensed in rate-adaptive pacemakers by a technology known as bioelectric impedance measurement (BIM). Many medical devices in addition to pacemakers use this technology. When one of these devices is used on a patient with an active, minute ventilation rate-adaptive pacemaker, the pacemaker may erroneously interpret the mixture of BIM signals created in the patient, resulting in an elevated pacing rate. For more information, see the FDA web site. http://www.fda.gov/cdrh/safety.html WARNING When using this transmitter with an ESU, the ESU return plate and the electrodes for monitoring must be firmly attached to the patient. If the return plate is not attached correctly, it may burn the patient’s skin where the electrodes are attached. Refer to the instruction manual for the ESU. CAUTION Turn off the power of cell telephones, small wireless devices and other devices which produce strong electromagnetic interference. Otherwise, the waveforms and measurements are affected by such interference and the displayed data may be incorrect. NOTE • Noise generated from an electrosurgery unit may interfere on an ECG waveform, but will not damage it. • If an electric blanket is used and incorrect heart rate is displayed on the monitor, turn off the pacing spike detection on the monitor. • Turn the pacing spike detection to ON on the monitor when monitoring a pacemaker patient. Pacing pulse is detected by the transmitter and transmitted to the monitor. If the pacing spike detection is turned OFF, QRS and pacemaker spike may not be distinguished and pacemaker failure may not be recognized. 54 Operator's Manual ZM-940PA Electrode Detachment In the following conditions, the check electrode indication is displayed on the LCD of the transmitter and the “CHECK ELECTRODE” message is displayed on the monitor. • Electrode is detached from skin. • Electrode lead is disconnected from the electrode. • Polarization voltage between the electrode and skin is excessively high. In these cases, check the cause and if necessary, replace electrodes with new ones. CAUTION When the “ELECTRODE OFF” or “CHECK ELECTRODE” message is displayed on the receiving monitor, check electrodes and electrode leads and remove the cause. While the “ELECTRODE OFF” or “CHECK ELECTRODE” message is being displayed, there is no ECG monitoring and no alarms. Check Electrode Indication on the Transmitter when Monitoring with 3 Electrodes The “ ” mark is displayed. Check electrode symbol Check Electrode Indication on the Transmitter when Monitoring with 6 Electrodes The “ ” mark and either the detached lead or detached electrode position is indicated, depending on the LEADS OFF DISPLAY setting on the PARAMETER SETUP screen. Check electrode symbol Check electrode indication When LEADS OFF DISPLAY is set to CHAR, the detached lead is indicated Operator's Manual ZM-940PA When LEADS OFF DISPLAY is set to IMAGE, the detached electrode position is indicated with X 55 SpO2 Monitoring When monitoring starts, SpO2 and pulse waveform are sent to the monitor and SpO2, pulse rate and pulse level bar graph are displayed on the transmitter LCD. WARNING • Measurement may be incorrect in the following cases. • When the patient’s carboxyhemoglobin or methemoglobin increases abnormally. • When dye is injected in the blood. • When using an electrical surgery unit. • During CPR. • When there is body movement. • When there is vibration. • When measuring at a site where there are venous pulses. • When the pulse wave is small (insufficient peripheral circulation). • When using an IABP (intra-aortic balloon pump). • Check the circulation condition by observing the skin color of the measuring site and pulse waveform. Change the measuring site every 8 hours for disposable probes and every 4 hours for reusable probes. The skin temperature may increase at the attached site by 2 or 3°C (4 or 5°F) and cause a burn or pressure necrosis. When using the probe on the following patients, take extreme care and change the measurement site more frequently according to symptoms and degree. • A patient with a fever • A patient with peripheral circulation insufficiency • Neonate or low birth weight infant with delicate skin • When not monitoring SpO2, disconnect the SpO2 cable from the transmitter. Otherwise, noise may interfere from the probe sensor and incorrect data is displayed on the screen. CAUTION • Turn off the power of cell telephones, small wireless devices and other devices which produce strong electromagnetic interference. Otherwise, the waveforms and measurements are affected by such interference and the displayed data may be incorrect. • Normally external light does not affect monitoring, however, strong light such as an operating lamp or sunlight may affect monitoring. If affected, cover the measuring site with a blanket. 56 Operator's Manual ZM-940PA • Do not pull or bend the probe cable, and do not run over the probe cable with caster feet. Do not immerse the probe cable in detergents or water. Failure to follow these cautions may cause cable discontinuity, short circuit, skin burn on the patient and incorrect measurement data. Replace any broken probe with a new one. • When the probe is attached on an appropriate site with sufficient circulation and the error message confirming the probe attachment repeatedly appears, the probe may be deteriorated. Replace it with a new one. • When the probe failure message appears on the screen, replace it with a new one. Otherwise SpO2 data may not be accurate. • While a patient is on medication which causes vasodilation, the pulse waveform may change and in rare cases the SpO2 value may not be displayed. NOTE In order to maintain sufficient blood circulation, keep the measurement site warm by covering it with a blanket or something similar. Warming the site is effective, especially for a patient with a small pulse amplitude. SpO2 and PR Display Order You can select the display order for SpO2 and PR (pulse rate) on the LCD. Refer to the “Changing Parameter Setup Settings” section. Monitoring SpO2 during NIBP Measurement When the SpO2 probe is attached to the same limb as the NIBP cuff, the blood flow decreases during NIBP measurement and pulse wave cannot be detected and SpO2 cannot be monitored properly. When “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen is set to ON (factory default setting), SpO2 monitoring is paused during NIBP measurement to avoid SpO2 alarm occurrence. However, when monitoring SpO2 on the same limb as NIBP, be careful when reading SpO2 values. When monitoring SpO2 is important, attach the probe to the limb to which the NIBP cuff or catheter is not attached. When SpO2 monitoring is paused during NIBP measurement, the SpO2 value just before the start of NIBP measurement and an mark are displayed on the transmitter for 30 seconds. When NIBP measurement is not completed after 30 seconds, “– – –” is displayed for the SpO2 value. The same data also appears on the monitor screen. Operator's Manual ZM-940PA 57 NOTE • When continuous SpO2 monitoring is necessary, attach the probe to the limb to which the NIBP cuff is not attached and set “INHIBIT SpO2 DURING NIBP” on the PARAMETER SETUP screen to OFF. • When the probe is attached to the same limb as the NIBP cuff, set the sync source to a parameter other than SpO2 on the receiving monitor. • When monitoring SpO2 during STAT NIBP measurement, attach the probe to the limb to which the NIBP cuff is not attached. 58 Operator's Manual ZM-940PA Display and Message List Battery Indication Indication Cause Countermeasure Fully charged battery Batteries are low. Batteries are low. NIBP cannot be measured. No indication Replace batteries. Dead batteries ECG/Respiration Indication Cause Electrode lead is disconnected from the electrode. Electrode lead is disconnected from the transmitter. Electrode lead discontinuity. Electrode is not firmly attached to the skin. Polarization voltage is abnormally high. Countermeasure Firmly connect the electrode lead to the electrode. Firmly connect the electrode lead to the transmitter. Replace the electrode lead with a new one. Replace the electrode with a new one. When monitoring ECG with 6 electrodes, the electrode or lead detached position is indicated by either lead or electrode position. This is set at LEADS OFF DISPLAY on the PARAMETER SETUP screen. Refer to the “Changing Parameter Setup Settings” section. LEADS OFF DISPLAY set to CHAR ECG ELECTRODE set to AHA LEADS OFF DISPLAY set to CHAR ECG ELECTRODE set to IEC LEADS OFF DISPLAY set to IMAGE Operator's Manual ZM-940PA 59 SpO2 Message During NIBP measurement Detecting body movement SpO2 CHECK PROBE SpO2 CHECK PROBE SITE SpO2 DETECTING PULSE SpO2 LIGHT INTERFERENCE SpO2 PROBE FAILURE Cause SpO2 monitoring is paused for NIBP measurement. Considerable body movement. The probe is not attached to the patient properly. The probe is not attached to the patient properly. The probe is not attached at the appropriate site. Probe is expired. Searching for the correct pulse wave. The SpO2 value cannot be obtained because the waveform is unstable. The probe is not attached to the patient properly. SpO2 measurement site is under fluorescent light, surgical light, sunlight, etc. Probe is expired. Probe is damaged or shortcircuited. Poor peripheral circulation. SpO2 WEAK PULSE 60 The probe is attached too tightly and is obstructing the blood circulation. Countermeasure Wait for NIBP measurement to finish. When the message is displayed frequently, check the patient condition and, if necessary, change the attachment site. Attach the probe to the patient properly. Attach the probe to a site 6 to 14 mm thick. Replace the probe with a new one. Wait until the pulse wave is detected. Attach the probe to the patient properly. Cover the measurement site with a blanket or cloth. Replace the probe with a new one. Replace the probe with a new one. Check the patient condition and change the attachment site. Check the probe attachment condition and if necessary, reattach the probe. Operator's Manual ZM-940PA NIBP Message NIBP AIR LEAK Cause The cuff and extension hose are not properly connected. The cuff hose (or extension hose) is not properly connected to the NIBP socket. The cuff or extension hose is damaged. Countermeasure Connect them properly. Replace with a new one. The patient’s pulse wave is small. Measure by palpation or auscultation. The cuff is not wrapped on the patient properly. Wrap the cuff on the patient properly. NIBP CUFF OCCLUSION Transmitter malfunction. Immediately remove the cuff from the patient and contact your Nihon Kohden distributor. NIBP HIGH CUFF PRESS Enormous pressure was applied by the pressure of the cuff. Remove the cause. NIBP INFLATION PRESS LOW Insufficient cuff inflation pressure. Wait for the remeasurement to be performed with increased cuff inflation pressure. NIBP MEAS TIMEOUT The measuring time exceeded the specified time due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed. Remove the cause if the cause is body movement, vibration or squeezing of cuff or hose. NIBP MODULE FAILURE Module malfunction. NIBP REMEASURING NIBP is being remeasured due to arrhythmia, body movement, vibration or, cuff or air hose being squeezed. NIBP SAFETY CIRCUIT RUNNING (When this message is displayed, measurement cannot be performed for 40 seconds.) Measurement stopped by the safety circuit. NIBP CANNOT DETECT PULSE NIBP SYS OUT OF RANGE NIBP WEAK PULSE NIBP ZEROING The maximum blood pressure cannot be measured even when the cuff inflation pressure exceeded 280 mmHg when using adult cuff. The patient’s pulse wave is too small. The cuff is wrapped too loosely. Contact your Nihon Kohden distributor. If the message still appears after remeasurement, remove the cause if the cause is body movement, vibration or squeezing of cuff or hose. Check that the hose is not bent or squeezed. Wait 40 seconds, then perform remeasurement. If the message still appears, contact your Nihon Kohden distributor. Measure by palpation or auscultation. Measure by palpation or auscultation. Wrap the cuff properly. The cuff size is not appropriate. Use the appropriate cuff. NIBP zero balance is being adjusted. Do not touch the cuff during zeroing. Wait for the message to disappear. Operator's Manual ZM-940PA 61 Troubleshooting If the problem still remains after checking the following, contact your Nihon Kohden distributor. Transmitter Problem Nothing is displayed on the LCD after turning the power on. LCD is difficult to see (too dark or too light). Cause Batteries are not installed correctly. The battery polarity is wrong. Batteries are completely discharged. LCD brightness is not appropriate. Nothing is displayed on the monitor after turning the transmitter power on. The channel of the transmitter and monitor does not match. The software version of the multiple patient receiver is old. Signal receiving condition is poor. Another transmitter of the same channel is used nearby. Signals are mixing. The transmitter is damaged. 62 Countermeasure Install the batteries correctly. Replace the batteries with new ones. Change the LCD brightness on the SYSTEM SETUP screen. Refer to the “Changing System Setup Settings” section. Set the correct channel on the monitor. Upgrade the multiple patient receiver software to receive signal from the transmitter. The software version must be 01-09 or later. Turn the transmitter power off. If the monitor still receives a signal, there is a high probability that another transmitter of the same channel is used nearby. Follow the instruction of your channel administrator and use another transmitter of a different channel. Follow the instructions of your channel administrator and use another transmitter of a different channel. Contact your Nihon Kohden distributor. Operator's Manual ZM-940PA ECG/Respiration Problem The heart rate is unstable. Cause Pacing detection setting on the monitor is not correct. The “CHECK ELECTRODE” message appears on the receiving monitor. Electrode lead is disconnected from the electrode. Electrode lead discontinuity ECG baseline is thick. (Hum is overlapping) Respiration waveform measurement is unstable. Electrode is not firmly attached to the skin. Polarization voltage is abnormally high. The gel on the electrode is dried out. The gel on the electrode is coming off. Electric blanket is used. Hum filter is set to OFF on the monitor The gel on the electrode is dried out. The gel on the electrode is coming off. Countermeasure Turn off the pacing detection setting on the monitor. When monitoring a pacemaker patient, turn on pacing detection. Firmly connect the electrode lead to the electrode. Replace the electrode lead with a new one. Replace the electrode with a new one. Use Nihon Kohden specified electrodes. Replace the electrode with a new one. Cover the blanket with a shield cover. Set the filter to ON. Replace the electrode with a new one. SpO2 Problem SpO2 data is unstable and not reliable. Cause The probe size is not appropriate for the patient. Probe attachment condition is poor. Probe is partly detached from the skin. External light gets in. Measurement site is dirty. Patient is wearing nail polish. Probe is attached to the same limb that is used for NIBP measurement. Countermeasure Use the appropriate probe for the patient. Firmly attach the probe according to the procedure in the probe operator’s manual. Remove dirt and nail polish. When the probe and cuff are attached to the same limb, set “INHIBIT SpO2 DURING NIBP” setting on the PARAMETER SETUP screen to ON. Attach the probe to the opposite limb. Avoid a site where blood circulation condition changes greatly. Operator's Manual ZM-940PA 63 NIBP Problem Cuff inflation pressure is less than 10 mmHg. The cuff does not inflate when the NIBP START/STOP key is pressed. Abnormal measurement results are displayed. Cause The cuff hose is not connected to the NIBP socket properly. The cuff is not wrapped around the arm or is wrapped too loosely. The cuff hose is not connected to the NIBP socket. The cuff hose or extension hose may be folded or squeezed when the cuff pressure display on the screen increases quickly but the actual cuff does not inflate. The cuff size is not correct. The cuff is not wrapped around the arm correctly. NIBP data is not correct because of body movement. Vibration on the cuff. The cuff is suddenly deflated during inflation. Auto mode measurement does not start even when the time interval has passed. The cuff suddenly inflates. Cannot connect cuff to the air hose. 64 Countermeasure Connect the cuff hose to the socket properly. Wrap the cuff around the upper arm. Connect the cuff hose to the socket firmly. Check the cuff hose and air hose. Select the cuff which fits the patient’s limb circumference. Wrap the cuff around the upper arm, not too tightly or too loosely. Prevent the patient from moving during measurement. Check that nothing is touching the cuff during measurement. Change the measuring site. The NIBP START/STOP key is pressed during inflation. The NIBP INTERVAL key is pressed and the measurement mode is changed. Check the measurement mode and interval. The measurement mode is set to auto mode. Unspecified cuff is used. Check the time interval. If necessary, stop measurement. Use a cuff specified by Nihon Kohden. Operator's Manual ZM-940PA Problem Cannot measure NIBP. Blood congestion occurs. Thrombus occurs. NIBP data on the screen is --- or dark. Three loud pip sounds indicting NIBP measurement cannot be started. Cause Vibration on the cuff. The cuff hose or extension hose is bent or squeezed. The cuff has worn out. Measuring over a long period of time at short intervals. Measuring on a patient with known bleeding disorders or coagulation. The time set for “OLD NIBP DATA” on the PARAMETER SETUP screen elapsed from the last measurement. The cuff is not deflated enough to start another measurement. Operator's Manual ZM-940PA Countermeasure Check that nothing is touching the cuff during measurement. Remove the cause. Use a new cuff. Increase the measuring interval. Do not measure NIBP over a long time. Do not perform NIBP measurement on such a patient. When NIBP is measured again, the data is displayed in normal brightness. Wait 30 seconds and measure again. 65 Maintenance To use the instrument in safe and optimum condition, perform maintenance check once every six months. CAUTION Do not disassemble the transmitter when performing maintenance and inspection. Do not repair the transmitter. When there is any problem with the transmitter after maintenance and inspection, contact your Nihon Kohden distributor. A maintenance check sheet is provided at the end of this section. Make a copy of this check sheet before performing maintenance check. 1. External Check • There are no damaged or dirty parts on the outside of the transmitter. • The battery case cover is not damaged, the spring is firmly fixed and the battery case cover can be closed firmly. • NIBP socket is not damaged. • Keys are not damaged. • Electrode leads are not damaged. • There is no blood or chemicals on the transmitter. 2. Transmitter Channel Check that the channel of the transmitter and the label match. 1. Check that the channel number label attached to the transmitter is not torn or removed. Channel label 66 Operator's Manual ZM-940PA 2. Remove one battery. 3. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 4. Press the NIBP INTERVAL key to move the cursor to “SYSTEM SETUP”. 5. Press the NIBP START/STOP key to enter the SYSTEM SETUP screen. The channel of this transmitter is displayed. 6. Check that the channel displayed on the LCD matches the label on the transmitter. Channel Operator's Manual ZM-940PA 67 3. LCD Display Check that there are no dots missing on the LCD. 1. Remove one battery. 2. While pressing the NIBP START/STOP and NIBP INTERVAL keys, install the battery. The SETUP screen appears. 3. Press the NIBP INTERVAL key twice to move the cursor to “MANUAL CHECK”. 68 4. Press the NIBP START/STOP key to enter the MANUAL CHECK screen. 5. Check that the cursor is on “LCD TEST” and press the NIBP START/ STOP key. Operator's Manual ZM-940PA 6. Every time the NIBP INTERVAL key is pressed, the screen changes as below. Check that there are no dots missing. When the NIBP START/STOP key is pressed, the screen returns to the MANUAL CHECK screen. 4. Key Operation NIBP START/STOP Key 1. Attach the NIBP cuff to your upper arm. 2. Press the NIBP START/STOP key. Check that the cuff inflates and deflates properly. 3. Press the NIBP START/STOP key again. During inflation, press the NIBP START/STOP key to check that the cuff deflates properly. NIBP INTERVAL Key 1. Press the NIBP INTERVAL key and check that the NIBP measuring mode can be changed. 2. Select any interval and press the NIBP START/STOP key to perform auto measurement. Check that the NIBP is measured at the selected interval. Operator's Manual ZM-940PA 69 5. NIBP Cuff for Attaching Transmitter to Patient Arm The NIBP cuff is a consumable. Check the following and when necessary, replace it with a new one. Appearance • There are no dirty parts. • There are no broken stitches on the cuff. • The label on the cuff is readable. • The velcro tape on the cuff is not removed and there are no broken stitches. • The lock plate is not damaged and functions properly. Inflation bag • The inflation bag is not torn or damaged. • There is no water inside the inflation bag. • The connector on the inflation bag is not damaged. 70 Operator's Manual ZM-940PA Maintenance Check Sheet Hospital/Organization: Service Personnel: Instrument Name: Transmitter Instrument Model: ZM-940PA Instrument Serial Number: Hardware Revision Number: Software Revision Number: 1. External Check OK No 2. Transmitter Channel OK No 3. LCD Display OK No 4. Key Operation OK No 5. NIBP Cuff for Attaching Transmitter to Patient Arm OK No Overall Judgement OK Can be used but needs maintenance Maintenance required. Cannot be used. Operator's Manual ZM-940PA 71 Repair Parts Availability Policy Nihon Kohden Corporation (NKC) shall stock repair parts (parts necessary to maintain the performance of the instrument) for a period of 8 years from the date of delivery. In that period NKC or its authorized agents will repair the instrument. This period may be shorter than 8 years if the board or part necessary for the faulty section is not available. 72 Operator's Manual ZM-940PA Lifetime and Disposal Disposing of Used Batteries Battery Lifetime Replace the batteries when the battery replacement indication appears on the transmitter. When using rechargeable batteries, recharge them. Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 2 days 2 days 2.5 days 1 day 2.5 days 3 days The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO2 is measured on an index finger of a male patient with weight 60 kg. Operation time depends on the thickness of SpO2 probe attachment site. Disposal NOTE Remove the batteries before disposing of the transmitter. Before disposing of the batteries, check with your local solid waste officials for details in your area for proper disposal. It may be illegal to dispose of these batteries in the municipal waste stream. Disposing of Electrodes, SpO2 Probes and NIBP Cuffs Refer to the manual of each item. Operator's Manual ZM-940PA 73 Cleaning, Disinfection and Sterilization Transmitter and Electrode Leads CAUTION • This transmitter is not waterproof. If detergent or liquid spills into the transmitter, stop cleaning/disinfecting/sterilizing it and contact your Nihon Kohden distributor. The transmitter needs to be checked for safety and function before use. • Before cleaning or disinfecting the transmitter, remove the batteries from the transmitter. • The transmitter cannot be sterilized. Cleaning Wipe the transmitter and electrode leads with a soft cloth moistened with disinfecting alcohol or neutral detergent diluted with water. After cleaning, dry them completely. Disinfection CAUTION • Do not immerse the electrode lead connector in liquid. • Do not disinfect with hypochlorous acid. • Use the recommended concentration. Wipe the outside surface of the transmitter and electrode lead with a non-abrasive cloth moistened with any of the disinfectants listed below. Use the recommended concentration. Disinfectant Glutaraldehyde solution Hydrochloric alkyl diaminoethylglycine Benzalkonium chloride Benzethonium chloride solution Chlorohexidine gluconate solution 74 Concentration (%) 2.0 0.5 0.2 0.2 0.5 Operator's Manual ZM-940PA SpO2 Probe Refer to the probe manual. YP-943P/944P NIBP Cuffs CAUTION • • • • Do not autoclave. Use only glutaraldehyde solution. Never allow liquid to get inside the rubber cuff. Do not sterilize or disinfect the cuff with ultraviolet light or ozone. Cleaning To clean the cuff, remove the lock plate and carefully pull out the inflation bag from the cloth cover. Cloth cover: Wash with neutral detergent and water. Thoroughly dry it. When washing in a washing machine, put it in a net. Inflation bag: Wipe with a soft cloth or cotton moistened with disinfecting alcohol. Thoroughly dry it. Disinfection To disinfect the cuff, use glutaraldehyde solution. Use the recommended concentration of the disinfectant. Refer to the disinfectant manual for details. After disinfection, clean the cuff as described above. Operator's Manual ZM-940PA 75 Specifications Measuring Parameters Measuring waveforms: Measuring numeric data: Transmitting Data Waveform data: Numeric data: Status information: ECG, Respiration in impedance method, pulse SpO2, NIBP, pulse rate ECG, respiration, pulse wave SpO2 and NIBP Battery replacement, channel ID, type of transmitter, check electrodes, abnormal polarization voltage, pacing data, SpO2 status Displayed Data SpO2, NIBP, pulse rate, pulse wave bar graph, check electrode, battery replacement, NIBP measurement mode and status information ECG Measurement Channels: Input range: DC offset: Input impedance: Pacing pulse detection: ±5 mV or more ±500 mV or more 5 MΩ or more (5 Hz) ANSI/AAMI EC13 Based upon Pacemaker pulse rejection Capability Respiration Measurement Measuring method: Impedance range: Impedance method 0 to 2 kΩ or less SpO2 Measurement Display range: Measuring range: Minimum display range: Depends on the receiving monitor 0 to 100%, in 1% steps 1% Measuring accuracy (When the measuring accuracy of the SpO2 probe is not considered): ±1 (80% ≤ SpO2 ≤ 100%) ±2 (50% ≤ SpO2 < 80%) Less than 50% is not specified. (When considering the measuring accuracy of the SpO2 probe): ±2 (80% ≤ SpO2 ≤ 100%) ±3 (70% ≤ SpO2 < 80%) Less than 70% is not specified. 76 Operator's Manual ZM-940PA NIBP Measurement Displayed items: Cuff pressure display range: Measurement modes: Systolic, diastolic, mean 0 to 300 mmHg Manual, STAT, auto at 5, 10, 15, 30, 60, 120 or 240 minute interval Pulse Rate 30 to 200 beats/minute ±8 beats/min (NIBP) Measuring range: 30 to 250 beats/min ±3% ±1 beat/min (SpO2) Transmitter FCC regulation: Field strength limits: Undesired emission: Antenna: Transmission channel: Transmission frequency range: Channel spacing: Type of emission: Occupied bandwidth: Effective radiated power: Power Requirements Operating voltage: Battery type: FCC part 95 Subpart H Wireless Medical Telemetry Service (WMTS) <200 mV/m (at 3 m) below 960 MHz: 200 µV/m (at 3 m) above 960 MHz: 500 µV/m (at 3 m) Internal indicated on the transmitter 608.0250 to 613.9750 MHz 50 kHz (25 kHz when interleave) F1D <20 kHz 1.0 mW (conducted) 3.2 to 4.8 V Three AA type NiMH secondary batteries Three AA type alkaline dry cell primary batteries Battery lifetime: Type NiMH secondary Alkaline primary Lifetime (Measuring parameters) ECG, SpO2, NIBP ECG, SpO2 ECG only 2 days 2 days 2.5 days 1 day 2.5 days 3 days The above data is when new batteries are used at room temperature, NIBP is measured in auto mode at 60 minute intervals and SpO2 is measured on an index finger of a male patient with weight 60 kg. Operation time depends on the thickness of SpO2 probe attachment site. Dimension and Weight Dimension: Weight: Operator's Manual ZM-940PA 114 W × 103 H × 58 D (mm) 280 g ±30 g (excluding batteries, NIBP cuff and other accessories) 77 Environment Operating environment Operating temperature: 5 to 40°C, 41 to 104°F When using NIBP cuff, 10 to 40°C, 50 to 104°F Operating humidity: 30 to 85% (non-condensing) Operating atmospheric pressure: 70 to 106 kPa Storage environment Storage temperature: −20 to 65°C, −4 to 149°F Storage humidity: 10 to 95% Storage atmospheric pressure: 70 to 106 kPa Safety Standards Safety standard: CAN/CSA-C22.2 No. 601-1 M90:1990 CAN/CSA-C22.2 No. 601-1. 1S1-94:1994 CAN/CSA-C22.2 No. 601-1. 1B-90:R2002 CAN/CSA-C22.2 No. 60601-2-49-04:2004 IEC 60601-1:1988 IEC 60601-1 Amendment1:1991 IEC 60601-1 Amendment2:1995 IEC 60601-1-2:2001 IEC 60601-2-27:1994 IEC 60601-2-30:1999 IEC 60601-2-49:2001 According to the type of protection against electrical shock: INTERNALLY POWERED EQUIPMENT According to the degree of protection against electrical shock: ECG and impedance method respiration: DEFIBRILLATION-PROOF TYPE CF APPLIED PART SpO2 and NIBP: DEFIBRILLATION-PROOF TYPE BF APPLIED PART According to the degree of protection against harmful ingress of water: IPX0 (Ordinary equipment) According to the degree of safety of application in the presence of a FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE: Equipment not suitable for use in the presence of FLAMMABLE ANAESTHETIC MIXTURE WITH AIR, OR WITH OXYGEN OR NITROUS OXIDE According to the mode of operation: CONTINUOUS OPERATION 78 Operator's Manual ZM-940PA Electromagnetic Compatibility IEC 60601-1-2 (2001) Emissions: CISPR11 Group1,Class B Electromagnetic Emissions This Model ZM-940PA is intended for use in the electromagnetic environment specified below. The customer or the user of the ZM-940PA should assure that it is used in such an environment. Emissions test RF emissions CISPR 11 Compliance Group 1 RF emissions CISPR 11 Harmonic emissions IEC 61000-3-2 Voltage fluctuations/ flicker emissions IEC 61000-3-3 Class B Electromagnetic environment guidance The ZM-940PA uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. The ZM-940PA is suitable for use in all establishments, including domestic establishments. Not applicable Not applicable Operator's Manual ZM-940PA 79 Electromagnetic Immunity This Model ZM-940PA is intended for use in the electromagnetic environment specified below. The customer or the user of the ZM-940PA should assure that it is used in such an environment. Immunity test IEC 60601 test level Compliance level Electrostatic discharge (ESD) IEC 61000-4-2 ±6 kV contact ±8 kV air Electrical fast transient/ burst IEC 61000-4-4 Not applicable ±2 kV for power supply lines ±1 kV for input/output lines Not applicable ±1 kV differential mode ±2 kV common mode <5% UT (>95% dip in Not applicable UT) for 0.5 cycle Surge IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11 Power frequency (50/60 Hz) magnetic field IEC 61000-4-8 NOTE 80 ±6 kV contact ±8 kV air Electromagnetic environment -Guidance Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. 40% UT (60% dip in UT) for 5 cycles 70% UT (30% dip in UT) for 25 cycles <5% UT (>95% dip in UT) for 5 s 3 A/m 3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment. UT is the AC mains voltage prior to application of the test level Operator's Manual ZM-940PA Immunity test IEC 60601 test level Compliance level Electromagnetic environment guidance Portable and mobile RF communications equipment should be used no closer to any part of the ZM-940PA, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter. Recommended separation distance Conducted RF IEC 61000-4-6 3 Vrms 3 Vrms d = 1.2√P Radiated RF IEC 61000-4-3 3 V/m 80 MHz to 2.5 GHz 3 V/m 80 MHz to 2.5 GHz d = 1.2√P 80 MHz to 800 MHz d = 2.3√P 800 MHz to 2.5 GHz where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m). Field strengths from fixed RF transmitters, as deter mined by an electromagnetic site survey*1, should be less than the compliance level in each frequency range*2. Interference may occur in the vicinity of equipment marked with the following symbol: NOTE 1: NOTE 2: At 80 MHz and 800 MHz, the higher frequency range applies. These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. *1 Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the ZM-940PA is used exceeds the applicable RF compliance level above, the ZM-940PA should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the ZM-940PA. *2 Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m. Operator's Manual ZM-940PA 81 Recommended Separation Distances between Portable and Mobile RF Communications Equipment The ZM-940PA is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the ZM-940PA can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ZM-940PA as recommended below, according to the maximum output power of the communications. Rated maximum output Separation distance according to frequency of transmitter (m) 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz power of transmitter (W) d = 1.2√P d = 1.2√P d = 2.3√P 0.01 0.12 0.12 0.23 0.1 0.38 0.38 0.73 1.2 1.2 2.3 10 3.8 3.8 7.3 100 12 12 23 For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. System Composition for EMC Test The ZM-940PA bedside monitor is tested to comply with IEC 60601-1-2 (2001) with the following composition. If any part which is not specified by Nihon Kohden is used, the EMC specifications may not comply. Units ZM-940PA transmitter YP-943P NIBP cuff BR-906P ECG electrode lead TL-201T finger probe 82 Cable length --0.15 m 0.8 m 1.6 m Operator's Manual ZM-940PA Standard Accessories No. Name NIBP cuff for adult, standard Strap Model YP-943P --- Q’ty Supply Code No. S938B Y236 The following parts are available for replacement. Lock plate is a standard accessory of the YP-943P/944P NIBP cuff. No. Name Battery case cover Lock plate Operator's Manual ZM-940PA Model Q’ty Supply Code No. 6144-012004 6113-049585 83 Options CAUTION Use only Nihon Kohden electrodes, electrode leads, SpO2 probes and NIBP cuffs to assure maximum performance from your instrument. Transmitter Channel writer, QI-901PK ECG/RESP Name Electrode lead Application 3 electrodes,clip type, lead length 80 cm 3 electrodes, snap type, lead length 80 cm 6 electrodes,clip type, lead length 80 cm 6 electrodes,snap type, lead length 80 cm Model Q’ty Supply Code No. BR-903PA K911A BR-913PA K910B BR-906PA K912A BR-916PA K915A NIBP Width (cm) Name Cuff for adult, for attaching transmitter to patient arm Cuff for infants Cuff for children Cuff for adult Standard 13 Large 15 10 13 15 12 14 16 Small Standard Standard Large Disposable cuff for infants Disposable cuff for children Disposable cuff for adults Small Standard Large Extension hose * The lock plate is provided with these NIBP cuffs. 84 Air Hose Length (cm) 15 15 20 150 Model YP-943P* YP-944P* YP-960T YP-961T YP-962T YP-963T YP-964T YP-910P YP-912P YP-913P YP-914P YP-915P YN-990P Q’ty 20 Supply Code No. S938B S938C S943A S943B S943C S944B S944C ----------S903 Operator's Manual ZM-940PA SpO2 Name Finger probe (reusable) Multi-site probe (reusable) SpO2 probe (for adult, disposable) SpO2 probe (for child, disposable) SpO2 probe (for neonate, disposable) Multi-site Y probe (for low birth weight infant/child/ neonate, disposable) SpO2 probe (for adult, disposable) SpO2 probe (for child, disposable) SpO2 probe (for neonate/adult, disposable) SpO2 probe (for child/infant, disposable) SpO2 probe(for adult/neonate, disposable) SpO2 probe (for child/infant, disposable) COTTONY tape Foam tape for TL-051S/052S/ 061S/062S Attachment tape for TL-220T/ 251T/252T/253T Attachment tape S for TL-260T Attachment tape L for TL-260T Operator's Manual ZM-940PA Cable length 0.6 m 1.6 m Model/ Code No. TL-201T Q’ty TL-220T TL-251T TL-252T TL-253T 1.6 m --- P201C TL-260T P205A TL-271T TL-272T P203A P203B TL-273T 0.8 m 1.6 m 0.8 m 1.6 m Supply Code No. P225H P225F P225G P201A P201B 24 P203C TL-274T P203D TL-051S TL-052S TL-061S TL-062S 340703 20 P228A P228B P229A P229B P259 4 × 25 package P260 3 × 30 package P263 24 P260A P260B --- 85 Transmission Frequencies USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 608.0250 608.0500 608.0750 608.1000 608.1250 608.1500 608.1750 608.2000 608.2250 608.2500 608.2750 608.3000 608.3250 608.3500 608.3750 608.4000 608.4250 608.4500 608.4750 608.5000 608.5250 608.5500 608.5750 608.6000 608.6250 608.6500 608.6750 608.7000 608.7250 608.7500 86 9002 9004 9006 9008 9010 9012 9014 9016 9018 9020 9022 9024 9026 9028 9030 9032 9034 9036 9038 9040 9042 9044 9046 9048 9050 9052 9054 9056 9058 9060 608.7750 608.8000 608.8250 608.8500 608.8750 608.9000 608.9250 608.9500 608.9750 609.0000 609.0250 609.0500 609.0750 609.1000 609.1250 609.1500 609.1750 609.2000 609.2250 609.2500 609.2750 609.3000 609.3250 609.3500 609.3750 609.4000 609.4250 609.4500 609.4750 609.5000 9062 9064 9066 9068 9070 9072 9074 9076 9078 9080 9082 9084 9086 9088 9090 9092 9094 9096 9098 9100 9102 9104 9106 9108 9110 9112 9114 9116 9118 9120 609.5250 609.5500 609.5750 609.6000 609.6250 609.6500 609.6750 609.7000 609.7250 609.7500 609.7750 609.8000 609.8250 609.8500 609.8750 609.9000 609.9250 609.9500 609.9750 610.0000 610.0250 610.0500 610.0750 610.1000 610.1250 610.1500 610.1750 610.2000 610.2250 610.2500 9122 9124 9126 9128 9130 9132 9134 9136 9138 9140 9142 9144 9146 9148 9150 9152 9154 9156 9158 9160 9162 9164 9166 9168 9170 9172 9174 9176 9178 9180 Operator's Manual ZM-940PA USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 610.2750 610.3000 610.3250 610.3500 610.3750 610.4000 610.4250 610.4500 610.4750 610.5000 610.5250 610.5500 610.5750 610.6000 610.6250 610.6500 610.6750 610.7000 610.7250 610.7500 610.7750 610.8000 610.8250 610.8500 610.8750 610.9000 610.9250 610.9500 610.9750 611.0000 611.0250 611.0500 611.0750 9182 9184 9186 9188 9190 9192 9194 9196 9198 9200 9202 9204 9206 9208 9210 9212 9214 9216 9218 9220 9222 9224 9226 9228 9230 9232 9234 9236 9238 9240 9242 9244 9246 Operator's Manual ZM-940PA 611.1000 611.1250 611.1500 611.1750 611.2000 611.2250 611.2500 611.2750 611.3000 611.3250 611.3500 611.3750 611.4000 611.4250 611.4500 611.4750 611.5000 611.5250 611.5500 611.5750 611.6000 611.6250 611.6500 611.6750 611.7000 611.7250 611.7500 611.7750 611.8000 611.8250 611.8500 611.8750 611.9000 9248 9250 9252 9254 9256 9258 9260 9262 9264 9266 9268 9270 9272 9274 9276 9278 9280 9282 9284 9286 9288 9290 9292 9294 9296 9298 9300 9302 9304 9306 9308 9310 9312 611.9250 611.9500 611.9750 612.0000 612.0250 612.0500 612.0750 612.1000 612.1250 612.1500 612.1750 612.2000 612.2250 612.2500 612.2750 612.3000 612.3250 612.3500 612.3750 612.4000 612.4250 612.4500 612.4750 612.5000 612.5250 612.5500 612.5750 612.6000 612.6250 612.6500 612.6750 612.7000 612.7250 9314 9316 9318 9320 9322 9324 9326 9328 9330 9332 9334 9336 9338 9340 9342 9344 9346 9348 9350 9352 9354 9356 9358 9360 9362 9364 9366 9368 9370 9372 9374 9376 9378 87 USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING USA BAND CHANNEL SPACING Transmission Transmission Transmission 25 kHz step 25 kHz step 25 kHz step frequency frequency frequency Channel No. Channel No. Channel No. (MHz) (MHz) (MHz) 612.7500 612.7750 612.8000 612.8250 612.8500 612.8750 612.9000 612.9250 612.9500 612.9750 613.0000 613.0250 613.0500 613.0750 613.1000 613.1250 613.1500 88 9380 9382 9384 9386 9388 9390 9392 9394 9396 9398 9400 9402 9404 9406 9408 9410 9412 613.1750 613.2000 613.2250 613.2500 613.2750 613.3000 613.3250 613.3500 613.3750 613.4000 613.4250 613.4500 613.4750 613.5000 613.5250 613.5500 613.5750 9414 9416 9418 9420 9422 9424 9426 9428 9430 9432 9434 9436 9438 9440 9442 9444 9446 613.6000 613.6250 613.6500 613.6750 613.7000 613.7250 613.7500 613.7750 613.8000 613.8250 613.8500 613.8750 613.9000 613.9250 613.9500 613.9750 9448 9450 9452 9454 9456 9458 9460 9462 9464 9466 9468 9470 9472 9474 9476 9478 Operator's Manual ZM-940PA
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